Provider Demographics
NPI:1154334555
Name:ROYER, OLIN D (PT)
Entity type:Individual
Prefix:MR
First Name:OLIN
Middle Name:D
Last Name:ROYER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:MR
Other - First Name:O
Other - Middle Name:DUANE
Other - Last Name:ROYER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:5035 MICAH CT SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97306-2855
Mailing Address - Country:US
Mailing Address - Phone:503-588-0192
Mailing Address - Fax:
Practice Address - Street 1:5125 SKYLINE RD S
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97306-9427
Practice Address - Country:US
Practice Address - Phone:503-361-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1415225100000X
WA8302225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist